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NPI Code Detail

MEDICARE: DOCTORS TESTING CENTER LLC II

MEDICARE: DOCTORS TESTING CENTER LLC II
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician
2247200000XOther Technician
3207Y00000XOtolaryngology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
25C652OTHERARMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15C724OTHERARIDTF

General Provider Information

NPI Number : 1922178060
Entity Type Code : Organization
Provider Name (Legal Business Name) : DOCTORS TESTING CENTER LLC II
Provider Business Mailing Address
First Line : 2227 WEST MAIN STREET
Second Line :
City : JACKSONVILLE
State : AR
Zip : 72076
Country : US
Telephone Number : 501-985-9944
Fax Number : 501-985-6590
Provider Business Practice Location Address
First Line : 2227 W MAIN ST
Second Line : SUITE 4
City : JACKSONVILLE
State : AR
Zip : 72076-4207
Country : US
Telephone Number : 501-985-9944
Fax Number : 501-985-6590
Authorized Official
Title or Position : PARTNER OFFICER
Name : MR. RONALD F DAVIS
Credential :
Telephone Number : 501-985-9944
Provider Enumeration Date : 11/08/2006
Last Update Date : 08/31/2007

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2227 W MAIN ST
JACKSONVILLE, AR
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1235320235 — MS. JULIANA BROOK DAVIS TECHNICIAN
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1215282108 — MISS RACHEL MARIE ROBERTSON
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2227 W MAIN ST
JACKSONVILLE, AR
72076-4207
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Practice Fax: 501-985-6590
1376892919 — HOLLIE PLUMMER
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2227 W MAIN ST
JACKSONVILLE, AR
72076-4207
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1407190234 — CANDINCE CHIMERA HODGES
Practice Location Address:
2227 W MAIN ST , STE #3
JACKSONVILLE, AR
72076-4207
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1447596648 — MR. CHRISTOPHER DOUGLAS BRATTON
Practice Location Address:
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72076-4207
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Practice Fax: 501-985-6590

Directions to “DOCTORS TESTING CENTER LLC II ” Practice Location

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